非住院 COVID-19 患者的血栓栓塞事件风险:系统评价。
Risk of thromboembolic events in non-hospitalized COVID-19 patients: A systematic review.
机构信息
Department of Pharmacology and Toxicology, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon; The Cardiovascular, Renal, and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon; Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD 21205, USA.
Department of Pharmacology and Toxicology, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon; The Cardiovascular, Renal, and Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon.
出版信息
Eur J Pharmacol. 2023 Feb 15;941:175501. doi: 10.1016/j.ejphar.2023.175501. Epub 2023 Jan 12.
The risk of thromboembolism in non-hospitalized COVID-19 patients remains uncertain and was assessed in this review to better weigh benefits vs. risks of prophylactic anticoagulation in this population. A search was performed through three databases: Medline, Embase, and Cochrane Library until 2022. Self-controlled case series, case-control and cohort studies were included, and findings summarized narratively. Meta-analyses for risk of thromboembolism including deep vein thrombosis (DVT), pulmonary embolism (PE), and myocardial infarction (MI) between COVID-19 and non-COVID-19 non-hospitalized patients were conducted. Frequency, incidence rate ratio (IRR), and risk ratio (RR) of stroke were used to assess risk in non-hospitalized COVID-19 patients considering the lack of studies to conduct a meta-analysis. Ten studies met inclusion criteria characterized by adult non-hospitalized COVID-19 patients. Risk of bias was relatively low. Risk of DVT (RR: 1.98 with 95% CI: 1.03-3.83) and PE (OR: 6.72 with 95% CI: 4.81-9.39 and RR: 4.44 with 95% CI: 1.98-9.99) increased in non-hospitalized COVID-19 patients compared to controls. Risk of MI (OR: 1.91 with 95% CI: 0.89-4.09) is possibly increased in non-hospitalized COVID-19 patients with moderate certainty when compared to controls. A trend in favor of stroke was documented in the first week following infection. Our meta-analyses support the increase in risk of DVT and PE, and likely increase of MI, in non-hospitalized COVID-19 patients. The risk of stroke appears significant in the first week following infection but drops to insignificance two weeks later. More studies are needed to establish evidence-based recommendations for prophylactic anticoagulation therapy in non-hospitalized COVID-19 patients.
非住院 COVID-19 患者发生血栓栓塞的风险尚不确定,本综述旨在评估该人群预防性抗凝的获益与风险比。通过 Medline、Embase 和 Cochrane Library 三个数据库进行了检索,检索时间截至 2022 年。纳入了自身对照病例系列、病例对照和队列研究,并进行了叙述性总结。对 COVID-19 与非 COVID-19 非住院患者之间深静脉血栓形成(DVT)、肺栓塞(PE)和心肌梗死(MI)的血栓栓塞风险进行了荟萃分析。由于缺乏进行荟萃分析的研究,因此使用频率、发病率比(IRR)和风险比(RR)来评估非住院 COVID-19 患者的中风风险。纳入了 10 项符合条件的研究,这些研究的特点是患有非住院 COVID-19 的成年患者。偏倚风险相对较低。与对照组相比,非住院 COVID-19 患者的 DVT(RR:1.98,95%CI:1.03-3.83)和 PE(OR:6.72,95%CI:4.81-9.39 和 RR:4.44,95%CI:1.98-9.99)风险增加。与对照组相比,非住院 COVID-19 患者的 MI(OR:1.91,95%CI:0.89-4.09)风险可能增加,但确定性为中等。在感染后第一周记录到有利于中风的趋势。我们的荟萃分析支持非住院 COVID-19 患者的 DVT 和 PE 风险增加,并且 MI 风险可能增加。在感染后第一周,中风风险似乎显著,但两周后降至无统计学意义。需要更多的研究来为非住院 COVID-19 患者的预防性抗凝治疗建立基于证据的建议。